BACKGROUND: The incidence of malignant melanoma has increased in recent years. Current therapies for metastatic melanoma include chemotherapy and a variety of immunotherapeutic choices. With no established standard treatment option, the evaluation of biochemotherapy is warranted. METHODS: A systematic review of the literature was conducted to locate randomized controlled trials, meta-analyses, systematic reviews, and evidence-based practice guidelines published up to April 2007. RESULTS: Nine eligible randomized controlled trials were identified, including six comparing chemotherapy alone to biochemotherapy (chemotherapy combined with interleukin-2 and interferon). Response rates were significantly higher with biochemotherapy in only two trials, although when data were pooled, biochemotherapy was superior to chemotherapy on response (relative risk, 1.52; 95% confidence interval, 1.24-1.87; p<0.0001) but did not delay time to progression (Hazard ratio, 0.80; 95% confidence interval, 0.63-1.01; p=0.06). Biochemotherapy was not associated with a statistically significant survival benefit in any of the individual trials or in a pooled analysis (Hazard ratio, 0.95; 95% confidence interval, 0.78-1.17; p=0.64). Biochemotherapy is a toxic therapy, and patients are likely to experience serious hematologic, gastrointestinal, cutaneous, and constitutional toxicities, although when conducted in the correct setting, grade 3 and 4 effects appear to be manageable, and treatment-related death can be minimized. CONCLUSION: The results of available studies are inconsistent with regard to benefit (response, time-to-progression, and survival) and show consistently high toxicity rates. Therefore, biochemotherapy is not recommended for the treatment of metastatic malignant melanoma in adults.
BACKGROUND: The incidence of malignant melanoma has increased in recent years. Current therapies for metastatic melanoma include chemotherapy and a variety of immunotherapeutic choices. With no established standard treatment option, the evaluation of biochemotherapy is warranted. METHODS: A systematic review of the literature was conducted to locate randomized controlled trials, meta-analyses, systematic reviews, and evidence-based practice guidelines published up to April 2007. RESULTS: Nine eligible randomized controlled trials were identified, including six comparing chemotherapy alone to biochemotherapy (chemotherapy combined with interleukin-2 and interferon). Response rates were significantly higher with biochemotherapy in only two trials, although when data were pooled, biochemotherapy was superior to chemotherapy on response (relative risk, 1.52; 95% confidence interval, 1.24-1.87; p<0.0001) but did not delay time to progression (Hazard ratio, 0.80; 95% confidence interval, 0.63-1.01; p=0.06). Biochemotherapy was not associated with a statistically significant survival benefit in any of the individual trials or in a pooled analysis (Hazard ratio, 0.95; 95% confidence interval, 0.78-1.17; p=0.64). Biochemotherapy is a toxic therapy, and patients are likely to experience serious hematologic, gastrointestinal, cutaneous, and constitutional toxicities, although when conducted in the correct setting, grade 3 and 4 effects appear to be manageable, and treatment-related death can be minimized. CONCLUSION: The results of available studies are inconsistent with regard to benefit (response, time-to-progression, and survival) and show consistently high toxicity rates. Therefore, biochemotherapy is not recommended for the treatment of metastatic malignant melanoma in adults.
Authors: Gwendoline Van Goietsenoven; Jenna Hutton; Jean-Paul Becker; Benjamin Lallemand; Francis Robert; Florence Lefranc; Christine Pirker; Guy Vandenbussche; Pierre Van Antwerpen; Antonio Evidente; Walter Berger; Martine Prévost; Jerry Pelletier; Robert Kiss; Terri Goss Kinzy; Alexander Kornienko; Véronique Mathieu Journal: FASEB J Date: 2010-07-19 Impact factor: 5.191
Authors: Peter A Prieto; Katherine H Durflinger; John R Wunderlich; Steven A Rosenberg; Mark E Dudley Journal: J Immunother Date: 2010-06 Impact factor: 4.456
Authors: Véronique Mathieu; Christine Pirker; Wolfgang M Schmidt; Sabine Spiegl-Kreinecker; Daniela Lötsch; Petra Heffeter; Balazs Hegedus; Michael Grusch; Robert Kiss; Walter Berger Journal: Oncotarget Date: 2012-04
Authors: D Schadendorf; S M Algarra; L Bastholt; G Cinat; B Dreno; A M M Eggermont; E Espinosa; J Guo; A Hauschild; T Petrella; J Schachter; P Hersey Journal: Ann Oncol Date: 2009-08 Impact factor: 32.976